Talk - Survey

Pretesting of Substance Abuse Prevention and Treatment and Mental Health Services Communications Messages

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0196 can be found here:

Documents and Forms

Document Name Document Type
Form Survey Talk - Survey Form and Instruction
Survey Survey 2015_12_2_OMB Package_CSAP UAD TTHY Evaluation-Survey-AttachmentC.docx Form and Instruction
Screener Screener 2015_12_2_OMB Package_CSAP UAD TTHY Evaluation-Survey-AttachmentA.docx Form and Instruction
2015_12_3_OMB Package_CSAP UAD TTHY Evaluation-Survey.docx Supporting Statement IC Document
TransLet-3doc.doc Transmittal Letter IC Document
2015_12_2_OMB Package_CSAP UAD TTHY Evaluation-Survey-AttachmentB.docx Email Letters IC Document

Information Collection (IC) Details

IC Title:	Talk - Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Survey	Survey	2015_12_2_OMB Package_CSAP UAD TTHY Evaluation-Survey-AttachmentC.docx		Yes	Yes	Fillable Printable
Form and Instruction	Screener	Screener	2015_12_2_OMB Package_CSAP UAD TTHY Evaluation-Survey-AttachmentA.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	2015_12_3_OMB Package_CSAP UAD TTHY Evaluation-Survey.docx	12/03/2015
Transmittal Letter	TransLet-3doc.doc	12/03/2015
Email Letters	2015_12_2_OMB Package_CSAP UAD TTHY Evaluation-Survey-AttachmentB.docx	12/03/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.